Archive for September, 2009

What’s the problem? The claim that the schizophrenic aren’t more dangerous. Actually, people with delusions are significantly more likely than those without to engage in physical assault – and the problem is that it’s very difficult to predict when they’ll do so.

Obviously, given ‘sane’ individuals can be very violent too, and if a given schizophrenic has no history of violent reactions there’s really no reason to think they’ll suddenly start. But all else being equal, they’re a greater danger to others than they’d otherwise be.

I’m not even going to touch the discussion of what the causes of schizophrenia are – that topic requires more work than is suitable for this post.

Well, sort of. They’re threatening to do so, possibly as a form of brinksmanship or hostage-taking. But as one commenter points out, their choices are to hold their functions hostage and try to get the proper funding or risk having their funding slowly reduced until their services shut down.

In some ways, the public is like the aphoristic frog in a slowly-boiling pot: they’ll notice sharp changes but not gradual ones. Shocking people by threatening to cut off everything at once is more likely to induce outrage and grass-roots activity than letting the libraries wither.

Libraries are one of the few government services I favor; it’s a terrible shame that the worthiest programs tend to have the hardest time getting funding. This is why we can’t have nice things, though – does our society deserve proper libraries if we force their caretakers to beg for enough money to keep services functioning?

Remember: talking to yourself isn’t a sign of madness. Most of human “thought” is just self-referential monologue. The difference is that normal people repress the expression and don’t actually verbalize, while schizophrenics have something wrong with the internal censor that prevents the interior self-discussion from being spoken.

That scene in “Austin Powers: International Man of Mystery” where Austin’s interior monologue is spoken aloud as a consequence of cryogenic trauma? It was meant as an absurdity, but it’s more accurate than either the writers or the audience likely realized.

Possibly the most important lesson that should be taken from the story of Charles Bonnet Syndrome (CBS) is that correlation implies nothing about causation and even less about etiology.

Patients with general dementia, Alzheimer’s, or strokes were far more likely to communicate seeing things that weren’t there. So if you merely look at reported population statistics, visual hallucinations would seem to be associated very strongly with brain damage.

But the real problem was that such patients were much more likely to be uninhibited in talking about their hallucinations. Older people with loss of sight but properly-working minds feared the consequences of mentioning what they saw to anyone – at least partially because of the existing association in physicians’ minds between visual hallucinations and senility – and so said nothing. And so there was no awareness of the true rate of the phenomenon.

If you look at the actual statistics – the ones collected once the stigma of CBS was reduced, physician awareness increased, and elders gently but insistently questioned – then there’s no particular association between senility or brain disease and the hallucinations.

Remember – it took hundreds of years for the condition to even be mentioned in the English language, despite all of the people who must have experienced vision loss and CBS in that time. Despite all of the physicians who must have aged or had eye damage and suddenly experienced it themselves.

The butler did it.
. . . well, the butler, and Cthulhu.
Cthulhu did most of the butchery.
But the butler let him in.
And held his knife.
And dusted him off afterwards
To help him disguise himself as the Christmas Tree.

He’s actually . . . Luke’s *father*.
But more astonishingly
Luke is *his*.
In episode three Luke warps too fast around the sun
Due to a problem with communication
And winds up in the past.
He builds two robots
And saves some whales
And has sex.
That’s why almost a quarter of his genes are an exact match with his own.
Remember, kids!
Midichlorians measure inbreeding!

The Iron Giant is friendly.
He loves people.
In fact, he loves them too much.
Just like Big Bird.

The owls are not what they seem.
They are luxury sedans with smooth, precise shifting,
High engine rev,
And dynamic performance.
See?
It’s a funky show.

Star Trek is based on the true story
Of Rasputin
And his faithful half-Vulcan companion,
Ivan.

What is the Matrix?
A tissue of false fate
Woven in the Wyld.

Sing, oh muse, of the wrath of Achilles
Sing, oh muse, of the birth of Ganesha
And of Iron John
And of that place
East of the sun, west of the moon.
And of all the old stories
Told by the Wyld
Before they were e’er told by men.

Superman comes back to life
Again
Later on.
Only now,
He’s radioactive.

In 1769, the Swiss naturalist and philosopher Charles Bonnet noticed that his nearly-blind grandfather reported vivid hallucinations of things which he knew to be non-existent. As his own sight worsened with age, Bonnet began to experience similar visions: birds, men and women, strange plants, and architectural patterns came and went. As he was the first person to describe this phenomenon, it was named after him: Charles Bonnet Syndrome.

The syndrome did not enter the English medical literature until 1982. Most physicians and nurses had never heard of it, and there was little literature about it even in non-English journals. Millions of people had seriously-impaired vision without experiencing CBS, so clearly it must be a very rare and unusual condition. If elderly people reported seeing things, it was considered to be overwhelmingly likely to be a sign of dementia or psychosis.

Until doctors actually sat down and questioned patients as to whether they had seen peculiar things, with no suggestions that they were insane or demented. Then it was recognized that more than half of all people with impaired vision, particularly those whose loss of sight occurred suddenly, experienced CBS.

Most of them were afraid they’d be considered mad if they mentioned what they saw to people, only about a third revealed the hallucinations to anyone, roughly a third lived in terror that they were losing their minds, and the vast majority did not tell their physicians. Unless actively encouraged to be honest, and given assurances that seeing things wasn’t a sign of insanity, many people simply denied their experiences if asked.

People who had strokes, were developing Alzheimer’s, and so on were indeed more likely to report having visions. Not necessarily because the visions resulted from neurological impairment, but because they were less likely to possess the contextual awareness of others and their expectations and repress mention of them.

This is a superb example of how important it is to always keep in mind the distinction between reality and our knowledge of it. Absence of evidence is not evidence of absence. Relying upon our collective knowledge base is often useful, but it prevents us from checking that base against reality and correcting it when wrong.

If you assumed that CBS must be rare and unusual, because there was no recognition of it in the literature and doctors knew nothing about it, you’d have make the implicit assumption that physicians’ knowledge was valid and complete. In reality, it wouldn’t be – not through any fault of the doctors, mind you. But you’d be ruling out in advance the possibility that the system itself was lacking, and so wouldn’t have been able to notice the problem and correct it.

Only once physicians actively considered the possibility that they were missing something, and sought out evidence from the patients themselves instead of what the profession thought it knew, was the gap between understanding and reality closed.